Birth Rates and their Affect on OB/GYN, Pediatrics, and Family Medicine Programs and Managing Resources in Times of Shortage


 

Authors: Treven Cade and Monisha Dhanasekar

While some states are experiencing an increase in births, America's overall birth rate has declined steadily throughout the past decades. With this decline, Germane has sought to ask, how will the declining, or changing, birth rates affect specialty GME programs associated with childbirth or the youth? These programs specifically would be Obstetrics and Gynecology (OB/GYN), Pediatrics, and Family Medicine. Germane has sought to inquire into this question by a series of steps: First, birth rates are measured by multiple metrics, such as crude birth rates and the annual number of children born each year; therefore, it is crucial to understand the different statistics utilized and the conflicting trends they create. Second, Germane has analyzed the ten states with the lowest birth rates and researched the number of total accredited programs and the three specialty programs in each state, per ACGME's Program Search. Third, we identified the five states with the highest increasing and decreasing rate of annual births within the last five years and have also identified their total number of programs and specialties. The lowest crude birth rates provide a snapshot in time; in contrast, the rate of the past five years illustrates which states are experiencing the most significant shift in births, highlighting any stresses that may be placed on those residency programs. Lastly, the primary care shortages within each of the states discussed will be showcased to elaborate on the needs of each state further. By analyzing these states with these differing birth rate statistics and shortages, one can see how birth rates may affect these specialty programs or how the specialty programs may need to increase in number due to these changes.

Birth rates are a complicated phenomenon to track and investigate. Perhaps most prominently due to the different metrics one can use that seemingly produce conflicting results; for example, data sites, such as MacroTrends (who source their data from the United Nations) showcase and project birth rate data of the United States of America using crude birth rates. A crude birth rate, which is respective to a population of 1,000 people, is calculated by taking the total number of births in a year and the total population and dividing both by 1,000 to produce the rate. For example, if there were 10,000 new births in a population of 10 million, the rate would be 10:1,000 (or 1.00) (Rosenberg). In comparison, other data sources will look at the number of births annually and compare that to previous years. If one looks at FIGURE 1 and 2, you can see how these two different metrics can produce different trends.

Similarly, if you look at the bottom half of FIGURE 3, you can see that the annual percentage change of the crude birth rate is increasing in both 2019 and 2020 at a rate of 0.9%. However, with that noted increase, you can also see seemingly conflicting sources say that 2020 had 4% fewer births than 2019, which marked six consecutive years of a declining birth rate (Solé). This discrepancy is due to the different metrics each source uses to illustrate birth rates. Although, in total, current data has showcased that the birth rate in America is declining and has been for quite some time (even though 2019-2020 has shown an increase in the annual percentage change of crude birth rates—which has not occurred in 30 years—it's predicted this trend could last until 2023, at which point after the declining rate would manifest once again for the foreseeable future). Germane will investigate both birth rate metrics. For our readers interested in birth rate changes for their specific hospital or program, we recommend looking into changes over time rather than one statistic from one year (this will be illustrated further down, as some of the states with the lowest crude birth rate are also listed among having the highest increasing or decreasing rate of births within five years).

FIGURE 1: Crude Birth Rates in America (which can be found here)

 

Figure 2: Average Annual Number of Births in America (which can be found here)

FIGURE 3: Crude Birth Rate in America with Annual Percent Change (can be found here)

Germane has investigated three groups of states that all represent different birth rate outcomes:

  • The ten states with the lowest crude birth rate
  • The five states with the highest rate of increase in births
  • The five states with the highest rate of decrease in births

After these statistics are showcased, each of the states' primary care needs will be illustrated to gather a concrete look into how these shortages of programs manifest themselves within the states. We have also identified the total number of accredited programs and the number of OB/GYN, Pediatrics, and Family Medicine programs in each state. The data that has been collected will be presented on TABLE 1, 2, 3, and 4 when the pertinent information is discussed. The culmination of this method will showcase potential strains brought about by births and their respective rates to the three specialty programs within each state. If birth rates were to influence these specialties, it would affect OB/GYN, Pediatrics, and Family Medicine in that order due to their proximity and involvement with childbearing and the youth. Although, in some cases, where states have low amounts of these specialty programs, they may not be affected by the birth rate but rather from the strain of having so few programs for the populations they serve.

Germane has investigated the ten states with the lowest crude birth rates. They are as follows (and are ordered lowest to highest): Vermont, New Hampshire, Maine, Connecticut, Rhode Island, Massachusetts, Oregon, West Virginia, Florida, and Pennsylvania. These states range from Vermont's 8.7 crude birth rate to Pennsylvania's 10.6 (for comparison, the two states with the highest crude birth rate are Utah and North Dakota with rates of 14.9 and 14.0 respectively, and America's average crude birth rate is around 12.0--a steadily declining number from 2015's rate of 12.3 or 2010s of 13.3) ("Birth Rate by State 2021" and "U.S. Birth Rate 1950-2021"). All these states, except for Oregon, were located on or near the East Coast. 

              TABLE 1 below illustrates the total number of accredited residency programs and the amount of OB/GYN, Pediatrics, and Family Medicine programs in each state. Beginning with the total amount of accredited programs, one will see that Pennsylvania, Florida, and Massachusetts have the most programs by a large margin. In contrast, Vermont, New Hampshire, and Maine have the least amount. These discrepancies are most generally applicable to the number of specialty programs in each state. For example, Vermont, New Hampshire, Maine, Rhode Island, and Oregon only have 1 OB/GYN and Pediatrics program. In contrast, Massachusetts has around 500 accredited programs with only about 6 of each specialty program—far less than Florida and Pennsylvania. While Massachusetts seems to be the outlying state, Family Medicine is generally the outlier of the specialty programs. In total, these states with the lowest crude birth rates typically do not have many OB/GYN, Pediatrics, or Family Medicine programs. Therefore, instead of being impacted by declining birth rates, the dilemma for these states and programs may be handling and decreasing the strain put onto them by a lack of necessary care.  

TABLE 1:  

States with the Lowest  
Crude Birth Rates

Total Number of  
Accredited Programs

OBGYN 
Programs

Pediatrics 
Programs

Family Medicine 
Programs

Vermont 

40

1

1

1

New Hampshire 

56

1

1

2

Maine 

36

1

1

4

Connecticut 

200

6

2

4

Rhode Island 

73

1

1

1

Massachusetts 

482

6

5

6

Oregon 

104

1

1

8

West Virginia 

93

3

3

8

Florida 

650

13

13

31

Pennsylvania  

795

17

7

50

 

Moving forward to showcase the increasing birth rates, while America's birth rate is declining, multiple states see increased births. The five states with the highest increasing rate of births from 2016-2021—the data from 2021 sourced from projections by the CDC—are as follows (ordered from highest to lowest) and are located in TABLE 2: New Hampshire (with an increasing rate of births of 18.98%), Maine (12.29%), South Carolina (11.86%), Rhode Island (10.23%), and Idaho (8.38%). Most of these states have a lower population, which means any subtle change in their number of births will create a higher rate than more populated states, but the changing rate can create a higher disturbance in low populations. For example, Maine and Idaho both had around 12,000 births in 2016 and 14,000 in 2021. Most notably, especially considering their rise in births, these states have little, or in some cases no, OB/GYN or Pediatric Programs. Because of their rising birth rate and amount of these specialty programs, these are perhaps the states in need of more OB/GYN, Pediatrics, and in some cases, Family Medicine programs.

As one may notice, Maine, New Hampshire, and Rhode Island were also listed among the states with the lowest crude birth rates, which reinforces our recommendation that each specific state or primary Medical School/Academic Medical Center analyze the changing rate of births rather than a single number in time. Especially when considering the need of the specialty programs in question, it is more important to note the changing rate because states with a low crude birth rate can still have a sustainable or sufficient number of programs; however, when rates increase or decrease, that sustainability may be harmed.

TABLE 2:  

States with the Highest Rate of 
 Increase in Births 
 (2016-2021)

Total Number of  
Accredited Programs

OBGYN  Programs

Pediatric 
Programs

Family Medicine  
Programs

Idaho (8.38%)

15

0

0

8

Maine (12.29%)

36

1

1

4

New Hampshire (18.98%)

56

1

1

2

Rhode Island (10.23%)

73

1

1

1

South Carolina (11.86%)

153

3

3

14

 

The states with the highest declining rate can now be discussed and analyzed (and can be seen below in TABLE 3). The states with the highest decline in the rate of births are as follows (and are ordered from highest to lowest): Delaware (with a decreasing rate of birth of -10.33%), New York (-5.64%), Alaska (-5.02%), California (-3.81%), and Connecticut (-3.41%). These five states, regarding their number of programs, can be easily divided into two groups: California and New York, with an extraordinary amount of accredited and pertinent specialty programs and Alaska, Connecticut, and Delaware with a low number of specialty programs and, in Alaska's case, an extraordinarily low number of accredited programs. New York and California will perhaps be the states whose OB/GYN, Pediatrics, and Family Medicine programs would be affected by the declining rate of births—as they have such a high number of programs along with a continuous decline in births. While, and once again, Alaska, Connecticut, and Delaware's programs may not strain from the declining rate of birth but from their lack of programs to address their populous (Alaska being the extreme example as, similar to Idaho, it has no OB/GYN or Pediatric program).

TABLE 3:

States with the Highest Rate of Decreasing Births (2016-2021)

Total Number of
Accredited Programs

OBGYN Programs

Pediatric Programs

Family Medicine
Programs

Alaska (-5.02%)

3

0

0

1

California (-3.81%)

1100

21

17

70

Connecticut (-3.41%)

198

6

2

4

Delaware (-10.33%)

39

1

1

3

New York (-5.64%)

1373

36

32

37

 

Family Medicine programs have, for most states, seemed to be the exception when it comes to specialty shortages, especially when compared to OB/GYN and Pediatric Programs. However, there is still a vast need for primary care providers. Primary care provider shortages have been recently increasing throughout the country. These shortages are categorized through HPSA (Health Professional Shortage Areas) designations, determined by the number of primary care health professionals concerning the area's population where the need is relatively high. Based on these designations, the states are ranked based on the shortages. According to The Hospital Review, there are approximately 7,203 areas in the United States with HPSA designations. Among these areas, the top five states are as follows: California (626 areas), Texas (411), Missouri (324), Alaska (301), and Florida (279). An aging population can explain these shortages, physicians entering retirement, and other metrics related to the country's looming physician shortage. Within TABLE 4 below, Germane has identified the primary care shortage areas of the states we have previously discussed, per a resource provided by Becker Healthcare. As one will see, even though states like California and New York have the most programs of the states discussed, they still have a strong need for primary care providers. Once again, the primary dilemma will be meeting the population's needs rather than being impacted by the lowering birth rate.

TABLE 4:

State

Number of HPSA Designated Primary Care Provider Shortage Areas

Vermont

15

New Hampshire

27

Maine

69

Connecticut

41

Rhode Island

14

Massachusetts

62

Oregon

144

West Virginia

105

Florida

279

Pennsylvania

139

Alaska

301

California

626

New York

168

Idaho

98

South Carolina

95

 

In total, America's overall birth rate is declining, while some states are individually experiencing an increase in the birth rate. In the cases where the birth rate is declining, the applicable states may not face an extreme effect from declining birth rates, as they are already struggling to provide care to their general population. However, if a state, such as California, has a decreasing rate of birth and a vast number of programs, they may face a unique problem of managing their shortage areas along with a declining rate of birth. On the contrary, the states experiencing an increase in birth rates, which are also struggling to fulfill the needs of their populous, will most likely be impacted the most because of their lack of OB/GYN, Pediatrics, and Family Medicine programs. Therefore, and perhaps paradoxically, in these specialty programs, while America is experiencing a birth rate decline, the states whose birth rate is increasing could be primarily affected. Perhaps America's physician shortage will be minutely eased by a declining birth rate, but this cannot be said for the states experiencing an increase. With the physician shortage, programs will have to be constructed strategically; thus, the states with the increasing birth rate will be in the most need of OB/GYN and Pediatric programs, while also focusing on their primary care need, as all other states must do.

Bibliography

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Rosenberg, Matt. "Understanding the Crude Birth Rate." ThoughtCo. January 20, 2019. Meaning of the Crude Birth Rate and Crude Death Rate (thoughtco.com).

 

Solé, Elise. "The U.S, Birth Rate is on the Decline—and No, It's not just because of the Pandemic." Microsoft News. May 6, 2021. The U.S. birth rate is on the decline — and no, it's not just because of the pandemic (msn.com).

 

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